3. New Classifications Flashcards by J L

2018 CLASSIFICATION FOR PERIODONTAL AND PERI-IMPLANT DISEASES AND CONDITIONS
Workgroup 1: ____ health and gingival diseases and conditions
Workgroup 2: ____
Workgroup 3: Other conditions affecting the ____
Workgroup 4: ____ diseases and conditions

periodontal
periodontitis
periodontium
peri-implant

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Periodontal Health, Gingival Diseases and Conditions

____ and gingival health
gingivitis: dental ____-induced
gingival diseases: ____-dental biofilm-induced

periodontal
biofilm
non

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Workgroup 1

Four categories of periodontal health

1.1 ____ periodontal health (rare but realistic)
Total absence of clinical inflammation

pristine

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Workgroup 1

1 Pristine periodontal health (rare but realistic)
- No ____, edema or pus
- Probing ≤ ____ mm (PD)
- No ____ on probing (BoP)
- No ____ (AL)
- No ____ loss

erythema
3
bleeding
attachment loss
bone

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Workgroup 1

1.2 Clinically periodontal healthy:
Absence or minimal levels of clinical inflammation

Probing ≤ ____ mm (PD)
____ bleeding on probing (BoP) < 10%
No ____ (AL)
No ____ loss

3
minimal
attachment loss
bone

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Workgroup 1

1.3 Periodontal disease stability:
Absence or minimal levels of clinical inflammation

Probing depth ≤ ____ mm (PD)
____ bleeding on probing (BoP) < 10%
____ (AL)
____ loss

4
minimal
attachment loss
bone

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Workgroup 1

1.3 Periodontal disease stability:
Successfully periodontal ____
Optimal reduction of ____, AL, minimal BoP
Lack of ____ destruction

treated
PPD
progressive

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Workgroup 1

1.4 Non-periodontitis patient:
Systemic disease affecting the periodontium

Probing depth ≤ ____ mm (PD)
____ bleeding on probing (BoP) < 10%
____ (AL)
____ bone loss

3
minimal
attachment loss
possible

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Workgroup 1

____ categories of plaque-induced gingivitis and modifying factors

three

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Workgroup 1

2.1 Associated with dental biofilm only: 
Due to bacterial \_\_\_\_ accumulation
\_\_\_\_ response of the gingival tissues 
Most \_\_\_\_ form of periodontal disease
Begins at the \_\_\_\_
Extend to the remaining gingival unit

plaque
inflammatory
common
gingival margin

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Workgroup 1

\_\_\_\_ with tooth brushing / in saliva 
\_\_\_\_
Gingival \_\_\_\_
Erythema
\_\_\_\_
No \_\_\_\_ loss
No \_\_\_\_ loss

bleeding
tenderness
swelling
halitosis
attachment
bone

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Workgroup 1

Intensity of signs and symptoms:

Vary among ____
Vary among sites within a ____

Control of gingival ____ is essential for the primary prevention of periodontitis

individuals
dentition
inflammation

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Workgroup 1

2 Potential modifying factors of plaque-induced gingivitis
- ____ conditions
- ____ enhancing plaque accumulation

systemic

oral factors

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Workgroup 1

2.2 Potential modifying factors of plaque-induced gingivitis:

Systemic conditions:
Sex steroid hormones
- \_\_\_\_
- Menstrual cycle
- \_\_\_\_
- Oral contraceptives

____
Leukemia
____
Malnutrition

puberty
pregnancy

hyperglycemia
smoking

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Workgroup 1

2.2 Potential modifying factors of plaque-induced gingivitis:

Oral factors enhancing plaque accumulation

Prominent ____ restorations margin
____
Pregnancy ____

subgingival
hyposalivation
gingivitis

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Workgroup 1

3 Drug influenced gingival enlargements:
- Antiepileptic: ____ and sodium valproate
- Calcium channel blocking drugs: ____, verapamil, amlodipine
- Immunoregulations drugs: ____
- High-dose ____

phenytoin
nifedipine
ciclosporine
contraceptives

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Workgroup 1

2.3 Drug influenced gingival enlargements:

Extent:

____ (single tooth or group of teeth)
____ (throughout the dentition)

Severity:

____ (enlargement of papilla),
____ (papilla and marginal gingiva)
____ (extends to the attached gingiva)

localized
generalized

mild
moderate
severe

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Workgroup 1
Plaque-induced gingivitis (all 3 categories)

Extent:

____ < 30%
____ ≥ 30%

localized

generalized

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Workgroup 1

Plaque-induced gingivitis (all 3 categories)

Severity: gingival index by Loe (1967)

0
Gingival status: ____ gingiva
Crtieria: Natural color ____ gingiva
No ____

1
Gingival status: \_\_\_\_ inflammation
Crtieria: Slight changes in \_\_\_\_ 
Slight \_\_\_\_
No \_\_\_\_ on probing

2
Gingival status: \_\_\_\_ inflammation
Crtieria: \_\_\_\_
\_\_\_\_ and glazing 
\_\_\_\_ upon probing

3
Gingival status: \_\_\_\_ inflammation
Crtieria: Marked \_\_\_\_ and edema 
\_\_\_\_
Spontaneous bleeding

normal
pink
inflammation

mild
color
edema
bleeding

moderate
redness
edema
bleeding

severe
redness
ulceration

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Workgroup 1

3.1 genetic/developmental disorders

____ (HGF)

hereditary gingival fibromatosis

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Workgroup 1

3.2 Specific infections
Bacterial origin: ____
Viral origin: ____ 1⁄2, HPV Fungal origin: ____

streptococcal gingivitis
herpes simplex
candidiasis

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Workgroup 1

3.3 Inflammatory and immune conditions and lesions Hypersensitivity reactions: ____ allergy
Autoimmune diseases of skin and mucous membranes: ____, lichen planus, lupus erythematosus
Granulomatous inflammatory conditions: ____

contact
pemphigus vulgaris
sarcoidosis

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Workgroup 1

3.4 Reactive processes
____
Peripheral giant cell granuloma
____

pyogenic granuloma

central giant cell granuloma

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Workgroup 1

3.5 Neoplasms
____: leukoplakia, erythroplakia
____: squamous cell carcinoma

premalignant

malignant

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Workgroup 1 ``` 3.6 Endocrine, nutritional, metabolic diseases ____ deficiencies ____ deficiency (scurvy) ```

vitamin | vitamin C

Workgroup 1 3.7 Traumatic lesions Physical/mechanical insults: ____ Chemical (toxics) insults: ____ Thermal insults: ____ of mucosa

tooth brushing chlorhexidine burns

Workgroup 1 3.8 Gingival pigmentation ____ ____-induced pigmentation ____ tattoo

smoker's melanosis drug amalgam

Periodontitis 1. ____ diseases 2. ____ 3. periodontitis as a manifestation of ____

necrotizing periodontal periodontitis systemic disease

Workgroup 2 ____ categories of Necrotizing Periodontal Disease

three

Workgroup 2 1.1 Necrotizing gingivitis Acute inflammatory process of the ____ tissues

gingival

Workgroup 2 1. 1 Necrotizing gingivitis - ____ of the interdental papillae - Gingival bleeding - ____ - Halitosis - ____ - Regional lymphadenopathy - Fever

necrosis/ulcer pain pseudomembranes

Workgroup 2 1.2 Necrotizing periodontitis Inflammatory process of the ____

periodontium

Workgroup 2 1. 2 Necrotizing periodontitis - Necrosis/ulcer of the interdental papillae - Gingival bleeding - Pain - Halitosis - Pseudomembranes - Regional lymphadenopathy - Fever - ____ loss

rapid bone

Workgroup 2 1.3 Necrotizing stomatitis ____ inflammatory condition of the periodontium

severe

Workgroup 2 1. 3 Necrotizing stomatitis - Necrosis/ulcer extends ____ the gingiva - Gingival bleeding - Pain - Halitosis - Pseudomembranes - Regional lymphadenopathy - Fever - ____ in the alveolar mucosa - ____ and bone sequestrum

beyond bone denudation osteitis

Workgroup 2 ____ categories of Necrotizing Periodontal Disease Host immune impairment: - ____ - Malnutrition - ____ infections - Stress

three immunosuppression viral

Workgroup 2 Three categories of Necrotizing Periodontal Disease - ____ - ____ - ____

papilla necrosis bleeding pain

Workgroup 2 Stages (I, II, III, IV) Severity of the disease - ____ loss - Radiographic bone loss - ____ loss Complexity of disease management - ____ - Horizontal bone loss - ____ loss - Furcation involvement - ____ mobility - Ridge deficiencies - ____ dysfunction

clinical attachment tooth probing depth vertical bone tooth masticatory

We are going to talk about general (dont understand..sorry). And we are going to mention it later on , so you can be more familiarized with the classification. Typically, when we talk about stage I and II, we talk about ____mm of attachment loss, more than ____ is stage III and IV. The radio graphical bone loss uses guidelines. When he came back to this: In terms of the tooth, stage I and II, there is no tooth loss due to periodontitis. In stage III, you have ____ loss , less than 4. In stage IV, you have more than ____ teeth loss due to periodontitis. In terms of complexity, for stages 1-2 , mainly ____ bone loss and stage III we have also ____ bone loss and ____ involvement. In stage IV, there is a more advanced scenario. It's complex. Its ____, bite collapse, less than 10 teen remaining in the patient. They need a complex treatment, prosthetically and periodontically.

1-4 5 tooth 5 horizontal vertical furcation malocclusion

They divide the roots into thirds. Coronal, middle, and apical third and based on that they look to see where bone loss is located and they say if its in the coronal third, its in stage ____. If its in the middle third its in stage ____

I and II | III and IV

Workgroup 2 Extent and distribution Localized (____%) ____ pattern

30 30 molar-incisor

Workgroup 2 Degree (A,B,C) Disease progression Direct evidence - ____ - RBL Indirect evidence - % ____ - phenotype Risk factors - ____ - diabetes

CAL bone loss/age smoking

Workgroup 2 With direct evidence, we have the phenotype that is more ____, so we see the patient and have little plaque or calculus or almost none and there is a lot of bone loss, mobility severe, then it is not directly proportional to the amount of dental plaque for the clinical scenario that the patient has is grad ____. To the contrary, if we see a lot of dental plaque and calculus and its light bone loss, we put it under the category of grade ____. The risk modifies, smoking and diabetes, we give them grade A-no smoker no diabetes, B-less than ____ cigs a day, and C-mor than ____ cigs a day. And for diabetes, less than ____ HbA1c and more than 7.0 HbA1c for people with grade C. So if the patient bone attachment loss did not change in 5 years, but the patient smokes a lot, more than 10 cigs, then we go to grade ____. So we always look for the most advanced factor that can be contributing to the periodontal Condition.

subjective C A 10 10 7.0 C

Other conditions affecting the periodontium 1. ____ diseases affecting the Periodontium 2. ____ and Endodontic-Periodontal Lesions 3. ____ Deformities 4. ____ Occlusal Forces 5. ____ and Tooth Related Factors

``` systemic periodontal mucogingival traumatic prosthesis ```

Workgroup 3 Disorder: Down syndrome Strength of association - ____

moderate

Workgroup 3 Disorder; strength of association - obesity; ____ - diabetes mellitus; ____ - osteoporosis; ____

significant significant significant

Workgroup 3 periodontal abscesses Localized ____ accumulation Within the wall of the ____/sulcus Significant ____ breakdown

pus periodontal pocket tissue

Workgroup 3 Periodontal abscesses - ____ elevation (gingiva and lateral part of the root) - Bleeding on probing - ____ - Suppuration - Deep ____ - Tooth mobility

ovoid pain periodontal pocket

Workgroup 3 Periodontal abscesses in periodontitis patients Untreated patients: (____) Treated patients: - After scaling and root planning (remaining ____) - After periodontal surgery (____, membranes) - Systemic antimicrobial (without ____ debridement)

periodontal pocket calculus sutures subgingival

Workgroup 3 Periodontal abscesses in non-periodontitis patients Healthy sites: - Impaction of ____ (dental floss, popcorn) - Harmful ____ (nail biting, biting wire) - ____ factors (inadequate orthodontic forces) - Gingival ____

foreign bodies habits orthodontic enlargement

Workgroup 3 Endodontic Periodontal Lesions ____ communication between the pulpal and periodontal tissue

pathologic

Workgroup 3 Endodontic periodontal lesions - Deep periodontal pocket extending to the ____ (primary sign) - Negative/altered response to ____ tests - Radiographic evidence of ____ in the apical or furcation region

root apex pulp vitality bone loss

Workgroup 3 Endodontic Periodontal lesions - ____ pain - Pain on palpation/percussion - Purulent ____/suppuration - Tooth mobility - ____/fistula - Crown and/or gingival color alterations

spontaneous exudate sinus tract

Workgroup 3 Endodontic Periodontal Lesions ``` Perio-endo ifnection Caries > ____ Periodontitis > ____ Periodontitis > ____ CHRONIC ``` ``` Trauma and iatrogenic factors ____ or cracking root canal or pulp chamber perforation ____ root resorption ACUTE ```

periodontium root canal caries root fracture external

Workgroup 3 Mucogingival deformities and conditions around teeth ``` 1. Periodontal biotype Thin scalloped biotype: - ____ triangular crown - ____ cervical convexity - Interproximal contacts close to the ____ - ____ KT - ____ gingiva - ____ alveolar bone ```

``` slender subtle incisal edge narrow thin thin ```

Workgroup 3 Mucogingival deformities and conditions around teeth ``` 1. Periodontal biotype Thick flat biotype: - ____-shape tooth crowns - ____ cervical convexity - Interproximal contacts more ____ - ____ zone of KT - ____ gingiva - ____ alveolar bone ```

``` square pronounced apical broad thick thick ```

Workgroup 3 Mucogingival deformities and conditions around teeth 2. Gingival / soft tissue recession - ____, lingual surfaces, ____

facial | interproximally

Workgroup 3 Mucogingival deformities and conditions around teeth 2. Gingival / soft tissue recession - Severity of recession (Cairo Classification) Recession Type 1 (RT1): Gingival recession with no loss of ____ ____ is clinically not detectable at both mesial and distal aspects of the tooth

interproximal attachment | interproximal CEJ

Workgroup 3 Mucogingival deformities and conditions around teeth 2. Gingival / soft tissue recession - Severity of recession (Cairo Classification) Recession Type 2 (RT2): ____ recession associated with loss of ____ Interproximal AL is less than or equal to the ____

gingival interproximal attachment buccal attachment loss

Workgroup 3 Mucogingival deformities and conditions around teeth 2. Gingival / soft tissue recession - Severity of recession (Cairo Classification) Recession Type 3 (RT3): Gingival recession associated with loss of ____ Interproximal AL is ____ than the buccal attachment loss

interproximal attachment | greater

Workgroup 3 Mucogingival deformities and conditions around teeth 2. Gingival / soft tissue recession - Gingival thickness = ____ mm

Workgroup 3 Mucogingival deformities and conditions around teeth 2. Gingival / soft tissue recession - Gingival width = ____ mm 3. Lack of ____ gingiva 4. Decreased ____ depth 5. Aberrant ____/muscle position 6. Gingival ____

``` 2 keratinized vestibular frenum excess ```

Workgroup 3 Traumatic occlusal forces primary occlusal trauma > ____ occlusal forces (tooth/teeth) > normal ____ support: - ____ CAL - ____ BL

excessive periodontal normal normal

Workgroup 3 Traumatic occlusal forces Secondary occlusal trauma > ____ occlusal forces (tooth/teeth) > ____ periodontal support: - ____ loss - ____ loss

normal/excessive reduced clinical attachment bone

Workgroup 3 Traumatic occlusal forces Clinical and radiographic indicators of occlusal trauma 1. ____ 2. Mobility 3. ____ discrepancies 4. Wear facets 5. Tooth ____ 6. Fractured tooth 7. ____ sensitivity 8. Discomfort / pain on chewing 9. Widened ____ space 10. Root resorption 11. ____ tear

``` fremitus occlusal migration thermal PDL cemental ```

Workgroup 3 Localized tooth related factors 1. Tooth anatomic factors - ____ projections - Developmental ____ groove 2. Root ____ 3. Cervical root resorption, cemental tears 4. Root ____ 5. Altered passive eruption

cervical enamel palatal fractures proximity

Workgroup 3 Localized dental prosthesis related factors 1. Restoration margins placed within the ____ attached tissues 2. Clinical procedures related to the fabrication of ____ restorations 3. Hypersensitivity / toxicity reactions to ____

supracrestal indirect dental material

Peri-Implant Diseases and Conditions 1. Peri-Implant ____ 2. Peri-Implant ____ 3. ____ 4. Peri-Implant ____ Tissue Deficiencies

health mucositis implantitis soft and hard

Workgroup 4 Peri-implant health - Masticatory and lining ____ - Mucosa averages high ____mm from mucosal margin to the crest of the peri-implant bone - Papilla height between an implant-supported restoration and natural tooth is ≤ ____ mm

mucosa 3-4 5

Workgroup 4 Peri-implant Health - Following implant, ____mm of bone occurs - PD > ____mm mm and/or crestal bone loss ≥ ____mm mm should be investigated for pathology - After this initial period 75% of implants experience no additional ____mm

5 2 bone loss

Workgroup 4 Peri-implant Mucositis - ____ - ____ weeks for resolution

reversible | 3

Workgroup 4 Peri-implant Mucositis - Predisposing factors: ____, cement - Plaque accumulation results in more severe ____ response around implants compared to natural teeth

plaque | inflammatory

Workgroup 4 Peri-implantitis - Difficult to define what is the normal ____ range around implants - Hx of ____ disease is a risk factors for peri-implantitis - Data for smoking and diabetes is ____

PD periodontal inconclusive

Workgroup 4 Peri-implantitis - Compliance with ____ interval reduces the risk of peri-implantitis - ____: potential risk factor - No evidence that ____ is a risk factor peri-implantitis

maintenance cement occlusal overload

So a patient with peri-implant health has no inflammation, no bleeding, and there isn't an increase in probing depth in future visits.The patient is stable. There is no more bone loss after the initial bone remodeling. Peri-implant mucositis has ____, ____ , ____, but no ____. For peri-implantitis we have all 4 of them.

inflammation BOP probing depth bone loss

``` Good (one or more of the following) • Adequate periodontal ____ (clinically and radiographically) • ____ to maintain • Adequate patient ____ • Control of the ____ factors ```

support easy cooperation etiologic

Fair (one or more of the following) • Approximately ____% attachment loss (clinically and radiographically) • ____ furcation involvement / Proper maintenance • Acceptable patient ____

25 class I cooperation

Poor (one or more of the following) • ____% attachment loss (clinically and radiographically) • ____ furcation involvement / Proper maintenance with difficulty

``` 50 class II ```

Questionable (one or more of the following) * Greater than ____% attachment loss (clinically and radiographically) * Poor ____ ratio * ____ furcation not easily accessible * ____ furcation * Mobility Grade ____ or greater * Significant root ____

``` 50 crown-to-root class II class III 2 proximity ```

Hopeless • Inadequate ____ to maintain the tooth • ____ performed or suggested

attachment | extraction